title: Contemporary revision penile prosthesis surgery is not associated with a high risk of implant colonization or infection: a single-surgeon series.
abstract: BACKGROUND
  Revision penile prosthesis surgery has traditionally been associated with a greater risk of postoperative infection than primary implant placement. This has been attributed to the high prevalence of asymptomatic bacteria found surrounding the implant at the time of revision surgery.
  
  
  OBJECTIVE
  To validate whether contemporary revision surgery remains associated with a high risk of asymptomatic colonization and postoperative infection.
  
  
  METHODS
  A comprehensive, prospective database consisting of consecutive patients undergoing primary and revision penile prosthesis surgery at our center was analyzed.
  
  
  METHODS
  The infection risk in primary and revision implant surgery was compared. The prevalence of asymptomatic implant colonization during revision surgery, and whether this was associated with clinical infection was evaluated. The spectrum of bacterial species causing infection in this contemporary single-surgeon series was described.
  
  
  RESULTS
  One hundred seventeen primary and 72 revision implant recipients were studied. Infection developed in four (3.4%) patients undergoing primary implants, two (4.3%) patients undergoing removal and replacement for mechanical malfunction, and three (12%) patients undergoing rerouting for extrusion (P = 0.26). Intraoperative cultures were positive in 5 (9.8%) of 51 revision patients, none of whom developed infections. Organisms causing infection included Staphylococcus aureus and Enterobacter aerogenes. Unexpectedly, an adjuvant, alcohol-based skin prep in our last 83 patients reduced the infection risk to 1.2%.
  
  
  CONCLUSIONS
  In our series, the infection risk associated with revision of malfunctioning devices was no greater than primary implant placement. Rerouting was associated with a higher infection risk, likely due to technical factors, and not implant colonization. Less than 10% of our revision implants were colonized, and this had no bearing on the development of a postoperative infection. S. epidermidis was not the most common organism implicated in device infections. Finally, our experience with an adjuvant, alcohol-based skin prep warrants further randomized prospective evaluation.
authors.affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA. bkava@med.miami.edu
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Kava
authors.forename: Prashanth
authors.initials: P
authors.lastname: Kanagarajah
authors.forename: Rajinikanth
authors.initials: R
authors.lastname: Ayyathurai
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D019935:Penile Implantation / Q000009:adverse effects*; D015917:Penile Prosthesis / Q000382:microbiology; D010413:Penis / Q000601:surgery; D011475:Prosthesis Failure / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000382:microbiology; D012086:Reoperation / Q000009:adverse effects*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology*